Patient Preference and Decision-Making

Patient Preference and Decision Making

Our hospital has a policy of working with patients and families to make treatment decisions across all the departments despite some situations that allow the doctors to overrule the patients’ decisions due to technical issues. A unique case occurred in our Catheterization Lab, which involved a STEMI patient who had been in the hospital for two months. At the time of discharge from the hospital, he needed Percutaneous Coronary Intervention for one of the vessels, which could be treated using a list of medicines prescribed by the cardiologists. During the medicine prescription, the patient raised issues of concern about the correct medicine to be administered. When the cardiologist finally prescribed ticagrelor, the patient insisted on being prescribed clopidogrel. Not convinced of the patient’s preference, the cardiologist did not change his prescription, making the patient accept the decision though not wholly convinced.

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After going home with the ticagrelor, the patient was readmitted with the same problem seven weeks later. By coincidence, when he was sent to the cath lab, he found me on duty. We had to conduct angioplasty to unblock the coronary artery because he had already developed severe stents restenosis. I had an interpersonal interrogation of the patient and discovered that he took the ticagrelor he was administered religiously, but the medicine supply got cut after only five weeks. According to him, the medicine prescribed was too expensive for him. He preferred the clopidogrel because it was available in the market and cheap compared to other medicines prescribed. The patient also continued taking aspirin, not knowing that it was dangerous and only required when taking the ticagrelor. I explained the patient’s concerns to the cardiologist, and this time around, he administered the clopidogrel preferred by the patient. After four months of changing the medication, the patient informed me that he was doing well and regaining his health.

Patient Preference

Access to information, primarily through the internet, allows the patient to note concerns unique to their medical prescriptions. The patient’s preference plays an essential role in care, treatment, and medication as the medical practitioner can understand the patient better and thus contribute to better outcomes (Stacey et al., 2017). Only under few cases should a doctor overrule the preference of the patient. In my case of the STEMI patient above, the patient had prior knowledge of the convenient prescription for his condition based on his financial challenges. The patient’s preference played a vital role in prescription and adherence to the medication. While missing the anti-platelet medication increased the risk of in-stent restenosis, the he struggled financially and could not afford the medicine prescribed. The medication should involve an open discussion of the patient to analyze the doctor’s recommendations against the patient’s preferences.

Use of Decision Aids

The evolution of the medical care industry involves the mass application of patients’ decision aids in treatment. According to the Ottawa Hospital Research Institute (2019), patient decision aids improve decision-making. They help clarify the patient’s values, reveal information about the patients’ preferred options, and help the doctor make explicit decisions for the patient’s benefit. While many medical institutions have proved patient decision aids to improve health outcomes, their adoption is not adequate. Thus, many health care institutions are missing the opportunity to improve their customer service. The tools also improve the interpersonal understanding between the patient and the doctor, increase the risk perception of the patient and improve the ultimate health care outcomes. The patient decision aids provide a better understanding of the decision-making criterion based on the situation a doctor comes across (Elwyn et al., 2018). No single decision aid will be entirely applicable in a given case since the decisions to get made differ from one case to another. While many patient decision tools could get applied and fit in my case, the Fibrillation Decision Support Tool was the most appropriate.

References

Elwyn, G., Burstin, H., Barry, M. J., Corry, M. P., Durand, M. A., Lessler, D., & Saigal, C. (2018). A proposal for the development of national certification standards for patient decision aids in the US. Health Policy, 122(7), 703-706.

Ottawa Hospital Research Institute. (2019). Patient Decision Aids. Web.

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Stacey D., Légaré F., Lewis K., Barry M.J., Bennett C.L., Eden K.B., Holmes-Rover, M., Llewellyn-Thomas, H., Lyddiat, A., Thomson, R., & Trevena, L. (2017). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, 2017(4). 1-242. Web.

Response 1

I agree with you that trauma service departments require patient preference in decision-making. The treatment of the trauma involves the doctor discussing with the patient to determine how the condition affects their social and psychological lives (Hoffman et al., 2020). In the case of an End-of-Life treatment plan, the doctor should assume the role of harmonizing the misunderstandings between the family members before extending the same to the patient. The patient, the family members, and the doctors should develop a common preference supported by most stakeholders to the treatment (Pope, 2017). Since the decision was complex, the palliative care team was appropriate for the case.

References

Hoffman, M. R., Morris, R., Smith, T., Denslow, S., & Schurr, M. (2020). Early comfort care following operative intervention for traumatic injury. The American Surgeon, 86(8), 933–936. Web.

Pope, T. M. (2017). Certified patient decision aids: solving persistent problems with informed consent law. The Journal of Law, Medicine & Ethics, 45(1), 12-40.

Response 2

In the Shared Decision-Making in the Pediatric Intensive Care Unit (PICU) case, the decision should not be made in a hurry since it attracts emotions from the family. Apparently, explicit sharing of information helps to avoid blame games. However, in my view, the autopsy decision made was not appropriate. According to Healthwise (2020), an autopsy decision is difficult and should only be made as a last resort. Advanced care planning would be appropriate for the family members to exhaust their efforts to treat the patient (Stacey et al., 2017). The method also assures the family hope, which is important in any treatment.

References

Healthwise. (2020). Autopsy: Should I have an autopsy done on my loved one? Web.

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Stacey D., Légaré F., Lewis K., Barry M.J., Bennett C.L., Eden K.B., Holmes-Rover, M., Llewellyn-Thomas, H., Lyddiat, A., Thomson, R., & Trevena, L. (2017). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, 2017(4). 1-242. Web.

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NerdyTom. 2022. "Patient Preference and Decision-Making." October 27, 2022. https://nerdytom.com/patient-preference-and-decision-making/.

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